Local Head Research Articles

Outcomes of Moderately Dose Escalated Hypofractionated Chemoradiation for Pancreatic Cancer

A modestly hypofractionated course of chemoradiation (CRT) consisting of 36 Gy/15 fractions (F) concurrent with gemcitabine used in PREOPANC and phase II trials has become increasingly common for the treatment of borderline resectable (BR) and locally advanced (LA) pancreatic cancer (PC). Achieving an R0 resection remains a key prognostic factor in PC. We tested whether escalating dose beyond standard dosing (SD) of 36-39 Gy/15 F (or 50-54 Gy/25-30 F) would improve R0 resection rates and outcomes while respecting nearby organs at risk. This was a retrospective analysis of consecutive patients at our institution from 2012-2022 with BR/LA PC treated with moderate dose escalated (MDE) (45 Gy/15 F, N = 45) or SD (36-39 Gy/15 F, N = 68 or 50-54 Gy/25-30 F, N = 25) CRT. For MDE, a 5 mm expansion from the duodenum, small bowel, and stomach was created (GI_PRV); PTV was cropped from this structure and prescribed 45 Gy/15 F. The primary endpoint was R0 resection rate with secondary endpoints of cumulative incidence of local progression (LP, recurrence after surgery/imaging progression if no surgery) with death as a competing risk (LP after occurrence of distant metastasis [DM] were still captured), cumulative incidence of DM, and overall survival (OS). Univariable and multivariable competing risks regression analyses were performed to determine the association between baseline covariates and LP. We identified 45 patients treated with MDE and 93 treated with SD. Most patients presented with BR disease (55.6% MDE; 54.8% SD) and received neoadjuvant chemotherapy with FOLFIRINOX (98% MDE; 99% SD). All patients in the MDE group and 99% in the SD group received concurrent chemotherapy with gemcitabine used most often (96% MDE; 77% SD). Median follow-up was 17 m (IQR 13-27 m). Surgical resection rates were similar between groups (33.3% MDE vs. 39.8% SD, p = 0.46). Amongst patients that had surgery, R0 resection rates were non-significantly higher in the MDE group (73.3% vs. 47.4%, p = 0.09). Cumulative incidence of LP at 18 m was significantly lower in the MDE group (9.0% vs. 24.8%, p = 0.04). No difference in rates of DM (51.2% MDE vs. 59.6% SD, p = 0.92) or OS at 18 m (53.9% vs. 53.6%, p = 0.89) were observed. On multivariable analysis, MDE (HR = 0.39, p = 0.03) and pancreatic head location (HR = 0.51, p = 0.04) were the only factors independently associated with LP. Rates of grade 2+ gastrointestinal toxicity during CRT (20% MDE vs. 20.9% SD, p = 0.91) and ≤90 days of completing CRT (11.6% MDE vs. 14.8%, p = 0.62) were similar between groups, as were rates of grade 3+ hematologic toxicity (52.3% MDE vs. 41.3% SD, p = 0.23). In this single institutional study, we found MDE is a simple, safe, and effective strategy associated with improved local control, higher R0 resection rates, and similar toxicity to SD CRT for patients with BR/LA PC. Further prospective data is needed to clarify the role of dose-escalated RT in the management of this lethal malignancy.

Clinicoradiological Factors Predicting Lymph Node Metastasis in Patients with Nonfunctioning Pancreatic Neuroendocrine Neoplasms: A Systematic Review and Meta-Analysis

Introduction: Lymph node metastasis of nonfunctioning pancreatic neuroendocrine neoplasms (pNENs) potentially leads to poor survival. Given the contradictory results in the literature regarding factors associated with lymph node metastasis of nonfunctioning pNENs, we conducted a systematic review and meta-analysis to determine the preoperative predictors of lymph node metastasis. Methods: Original studies reporting factors associated with lymph node metastasis in patients with nonfunctioning pNENs were identified in PubMed, EMBASE, and Cochrane Library databases, and data from eligible studies were analyzed using random-effects meta-analysis to obtain pooled estimates of odds ratios (ORs) and their 95% confidence intervals (CIs). Results: Eleven studies were included. Tumor size (>2 cm or >2.5 cm; OR, 5.80 [95% CI, 4.07–8.25]) and pancreatic head location (OR, 1.75 [95% CI, 1.05–2.94]) were significant preoperative predictors of lymph node metastasis. Old age (OR, 1.07 [95% CI, 0.68–1.68]) and male sex (OR, 1.12 [95% CI, 0.74–1.70]) were not significantly associated with lymph node metastasis. Conclusions: A large tumor size and pancreatic head location can be useful for planning optimal treatment in patients with nonfunctioning pNENs.

Melanoma-specific survival in worse in the elderly: a multicentric cohort study.

We aimed to characterise cutaneous melanoma in the elderly and determine its association with poorer prognosis. We studied a prospective cohort of the melanoma population in Catalonia between 2012 and 2016. We compared young patient group (<75 years old) with elderly patient group (≥75 years old). We included 3009 patients (52.5% women) from 14 centres, with a mean age at diagnosis of 61.1 years. In the ≥75-year-old group there was a predominance of men (53.9% vs. 45.5%, P < 0.001), melanoma was more frequently located in the head and neck area (37.7% vs. 15.5%, P < 0.001) and lentigo maligna melanoma subtype was significantly more frequent (31.4% vs. 11.6%, P < 0.001), as were nodular melanoma and acral lentiginous melanoma (P < 0.001). In older people, Breslow index, the presence of ulceration and mitotic rate were higher than in younger people. Kaplan-Meier survival curves showed longer melanoma specific survival (MSS) and melanoma-free survival (MFS) in <75-year-old group compared to the elderly group. Cox regression models demonstrated reduced MSS in patients ≥75 years regardless of gender, location, IB, ulceration and lymph node status at diagnosis (HR 1.54, P = 0.013) whereas MFS was not independently associated with elderly when head and neck location was considered. Age appears to be an independent risk factor for MSS but not for MFS. Worse melanoma prognosis in elderly could be explained by factors unrelated to the tumour, such as age-related frailty and comorbidities that limit the access to systemic treatments and, eventually, age-related immune dysfunction.

보육교직원(보육교사)의 권익보호 관련 문제점 및 개선방안 - 관련법과 자치단체조례 분석을 중심으로 -

This study aimed at 27 local governments that have relevant laws(Infant Child Care Act, Early Childhood Education Act, Educational Public Officials Act, Special Act on the Promotion of Teachers' Status and Protection of Educational Activities) and related ordinances to date, 'protection and promotion of rights and interests of childcare teachers'. By analyzing the Ordinance for (Support)', the legal status of childcare staff (childcare teachers) and the problems of the regulations related to the protection of rights and interests will be examined, and based on this, improvement plans will be suggested. Based on this, the main purpose of the study is to provide basic data for future related laws(Infant Care Act) and local government ordinance enactment/revision and retention integration law(tentative name, Infant Education and Child Care Act).&#x0D; Based on the problems found in the research results, we would like to suggest improvements as follows.&#x0D; First, the main problems and improvement measures related to the Infant Care Act are: 1) the legal status of childcare teachers; It should be improved so that the status of teachers under the Education Act is secured on an equal basis with kindergarten teachers, and the protection of teaching rights according to the position of teachers is guaranteed. 2) definition of childcare staff(childcare teacher); As in the Early Childhood Education Act, it is desirable to define teachers(directors and nursery teachers) and staff other than teachers. Next, childcare staff duties; As in the Early Childhood Education Act, it should be improved so that it is divided into director, supervisor, head teacher, teacher, and administrative staff to be more specifically defined. 3) Responsibility to protect the rights and interests of childcare teachers; In order to apply the law more effectively, it is necessary to improve the current voluntary regulations into mandatory regulations such as 'The state and local governments must actively promote necessary policies and prepare measures for training childcare teachers, improve working conditions, and protect their rights and interests.' I think it's possible.&#x0D; Second, the main problems and improvement measures related to local government ordinances for improving treatment and rights of childcare staff are: 1) Responsibilities of local government heads; It seems desirable to stipulate the two contents together as ‘relevant systems and conditions and necessary policies must be actively pursued’ and ‘efforts must be made to create a social atmosphere’. 2) establishment of a basic (comprehensive) plan; It seems desirable to stipulate that it should be done every five years, and it is desirable that voluntary regulations should be improved to mandatory regulations such as ‘must be established and implemented’. 3) fact-finding; It should be improved with mandatory regulations such as ‘a fact-finding survey should be conducted every three years’. 4) rights protection support project; Since almost all local governments stipulate that 'the head of a local government may promote(implement) a project to improve the treatment of childcare teachers and improve their rights and interests.' 5) Establishment and operation of the Rights Protection Committee; Since the establishment of the most important committee must be established and operated to improve the treatment and rights of childcare staff, it would be desirable to have a mandatory rule rather than an arbitrary rule. 6) establishment of cooperation system; There were only three local governments that stipulated a mandatory regulation. If possible, it would be desirable to establish a cooperative system through mandatory regulations rather than voluntary regulations. 7) Others

Local government innovation model in Pekanbaru City, Indonesia: a study of public service mall

This research aims to find a model for implementing local government innovation in Pekanbaru City. One of the Innovation Public Service Mall innovations with the highest score is SMART PETAKU (Pekanbaru City Government Land Asset Management System) with a score of 820. However, there are still several innovations with the lowest score, one of which is the E-Archive with a score of 0. Using the theory of disruptive innovation ( Yu Hang, 2010), the basic design of this study uses a qualitative method with a descriptive approach from primary data sources obtained from in-depth interview techniques and secondary data, namely passive observation techniques. The research findings show that first, the success of the internal perspective is determined by the indicators of visionary and innovative local government head leadership, the right organizational structure with the establishment of a Public Service Mall, an organizational culture that is not separated from the pathology of democracy, and employee competencies that require development. Second, an external perspective determined by supervision from the Pekanbaru City DPRD, community participation, and appreciation factors that have a significant effect on the performance of the Pekanbaru City Government. Third, the marketing aspect is supported by the existence of a dynamic website from the content and information presented. Fourth is the technological perspective, where the Pekanbaru City Government through the Public Service Mall applies the E-Gov concept with application designs for requests and complaints. The conclusion of the study found the IEMT model with internal, external, market, and technology perspective dimensions. Recommendations for further research are collaborative governance studies in service innovation with the private sector at Public Service Malls which are still disproportionate.

우리나라 지방자치단체 운영성과 제고방안에 관한 연구

In order to improve more reasonably and productively in a series of administrative operations and policy processes in Korean local governments, systematic operational performance evaluation of administrative work execution results was recognized as an important management function. It will be possible to promote the development of local administration and enhance administrative autonomy and accountability by checking the productivity of local governments' administrative operations and conducting a rigorous and accurate evaluation of leadership and administrative performance. In this context, this study will review the evaluation areas and measurement indicators of local government operation performance for local government evaluation, extract the determinants of local government evaluation through a review of previous studies, present a performance evaluation model and seek policy directions to improve operational performance. This study on efficient local government operation plans and the role and leadership direction of local government heads can recognize their importance from a political, social, economic, and customer (resident)-oriented perspective. Only when the evaluation system for local government's operational performance is established and utilized under mutual connection with local residents will the local government increase its efforts to improve the quality of life and maximize residents' satisfaction, and regional development policies can also be implemented from a long-term perspective.

Automatic 3D Postoperative Evaluation of Complex Orthopaedic Interventions.

In clinical practice, image-based postoperative evaluation is still performed without state-of-the-art computer methods, as these are not sufficiently automated. In this study we propose a fully automatic 3D postoperative outcome quantification method for the relevant steps of orthopaedic interventions on the example of Periacetabular Osteotomy of Ganz (PAO). A typical orthopaedic intervention involves cutting bone, anatomy manipulation and repositioning as well as implant placement. Our method includes a segmentation based deep learning approach for detection and quantification of the cuts. Furthermore, anatomy repositioning was quantified through a multi-step registration method, which entailed a coarse alignment of the pre- and postoperative CT images followed by a fine fragment alignment of the repositioned anatomy. Implant (i.e., screw) position was identified by 3D Hough transform for line detection combined with fast voxel traversal based on ray tracing. The feasibility of our approach was investigated on 27 interventions and compared against manually performed 3D outcome evaluations. The results show that our method can accurately assess the quality and accuracy of the surgery. Our evaluation of the fragment repositioning showed a cumulative error for the coarse and fine alignment of 2.1 mm. Our evaluation of screw placement accuracy resulted in a distance error of 1.32 mm for screw head location and an angular deviation of 1.1° for screw axis. As a next step we will explore generalisation capabilities by applying the method to different interventions.

Novel CAF-identifiers via transcriptomic and protein level analysis in HNSC patients

Cancer-associated fibroblasts (CAFs), a prominent component of the tumor microenvironment, play an important role in tumor development, invasion, and drug resistance. The expression of distinct “CAF-markers” which separates CAFs from normal fibroblasts and epithelial cells, have traditionally been used to identify them. These commonly used CAF-markers have been reported to differ greatly across different CAF subpopulations, even within a cancer type. Using an unbiased -omic approach from public data and in-house RNAseq data from patient derived novel CAF cells, TIMP-1, SPARC, COL1A2, COL3A1 and COL1A1 were identified as potential CAF-markers by differential gene expression analysis using publicly available single cell sequencing data and in-house RNAseq data to distinguish CAF populations from tumor epithelia and normal oral fibroblasts. Experimental validation using qPCR and immunofluorescence revealed CAF-specific higher expression of TIMP-1 and COL1A2 as compared to other markers in 5 novel CAF cells, derived from patients of diverse gender, habits and different locations of head and neck squamous cell carcinoma (HNSC). Upon immunohistochemical (IHC) analysis of FFPE blocks however, COL1A2 showed better differential staining between tumor epithelia and tumor stroma. Similar data science driven approach utilizing single cell sequencing and RNAseq data from stabilized CAFs can be employed to identify CAF-markers in various cancers.

Analisis Yuridis Perjanjian bagi Hasil Perpecahan Lahan Pertanian di Desa Dengkol Kabupaten Malang

This scientific paper analyzes the juridical analysis of profit-sharing agreements on split land in Dengkol Village, Malang Regency. The legal issue to be analyzed is a land dispute case in Malang Regency. The purpose of this research is to reach an agreement on land disputes that benefit both parties, namely between the Air Force and the Community and to find out the problems that occur and result in land disputes. This study uses a normative legal research method based on a study of cases and laws and regulations. The land dispute that occurred in Malang Regency was proven to have occurred due to incitement carried out by the local village head who was assisted by irresponsible persons, in this case it was also resolved in a non-litigation manner which was carried out outside the court and carried out by mediation.

Shadow Hunter: Low-Illumination Object-Detection Algorithm

Recently, object detection, which is focused on images with normal illumination levels, has achieved great success. However, the accuracy of object detection is reduced in suboptimal environments due to the images plagued by noise and low contrast. For boosting the performance of object-detection tasks under low-illumination conditions, we propose three modules for improvement: (1) the low-level feature attention (LFA) module learns to focus on the regional feature information of the object in the low-illumination environment, highlighting important features and filtering noisy information; (2) the feature fusion neck (FFN) obtains enriched feature information by fusing the feature information of the feature map after backbone; (3) the context-spatial decoupling head (CSDH) enables the classification head to focus on contextual semantic information so that the localization head obtains richer spatial details. Extensive experiments show that our algorithm realizing end-to-end detection shows good performance in low-illumination images.

A cluster-based trusted routing method using fire hawk optimizer (FHO) in wireless sensor networks (WSNs)

Today, wireless sensor networks (WSNs) are growing rapidly and provide a lot of comfort to human life. Due to the use of WSNs in various areas, like health care and battlefield, security is an important concern in the data transfer procedure to prevent data manipulation. Trust management is an affective scheme to solve these problems by building trust relationships between sensor nodes. In this paper, a cluster-based trusted routing technique using fire hawk optimizer called CTRF is presented to improve network security by considering the limited energy of nodes in WSNs. It includes a weighted trust mechanism (WTM) designed based on interactive behavior between sensor nodes. The main feature of this trust mechanism is to consider the exponential coefficients for the trust parameters, namely weighted reception rate, weighted redundancy rate, and energy state so that the trust level of sensor nodes is exponentially reduced or increased based on their hostile or friendly behaviors. Moreover, the proposed approach creates a fire hawk optimizer-based clustering mechanism to select cluster heads from a candidate set, which includes sensor nodes whose remaining energy and trust levels are greater than the average remaining energy and the average trust level of all network nodes, respectively. In this clustering method, a new cost function is proposed based on four objectives, including cluster head location, cluster head energy, distance from the cluster head to the base station, and cluster size. Finally, CTRF decides on inter-cluster routing paths through a trusted routing algorithm and uses these routes to transmit data from cluster heads to the base station. In the route construction process, CTRF regards various parameters such as energy of the route, quality of the route, reliability of the route, and number of hops. CTRF runs on the network simulator version 2 (NS2), and its performance is compared with other secure routing approaches with regard to energy, throughput, packet loss rate, latency, detection ratio, and accuracy. This evaluation proves the superior and successful performance of CTRF compared to other methods.

PENINGKATAN KUALITAS HIDUP LANSIA MELALUI PENERAPAN POLA HIDUP SEHAT DI PERUM OMA INDAH DESA GODOG KARANGPAWITAN GARUT

Introduction: Old age (elderly) is a period that people will experience eventually. Many people can enjoy old age, but a few also experience illness and die without being able to enjoy old age happily. Objective: to provide information about healthy behavior in living life in old age so that it is always healthy and quality. Methods: This community service uses extension techniques with several stages of activities, namely the planning stage of activities to be carried out by identifying needs, identifying existing potentials and weaknesses, determining solutions and activities to be carried out, and organizing activities and the implementation stage of service activities in the form of solutions that have been approved by the local RW head. Results: This service activity results in improving the quality of elderly health by maintaining diet, sleep patterns and exercising so that the health of the elderly is maintained. Conclusion: The implementation of this community service activity received a good response from the community, especially the Perum Oma Indah community in Godog Village, Karangpawitan Garut. From these community service activities, the knowledge of the elderly has increased and the quality of life of the elderly with clean and healthy patterns or behavior both in the environment or healthy behavior for each individual is provided with a pocket book that can be a guide for the elderly as information or knowledge in everyday life.

Experimental investigation on flow of trash rack blockage in front of pumping station

Trash rack blockage significantly affects the water levels and velocity distributions near trash racks, influencing the performance of subsequent hydraulic systems. An experiment was conducted where alligator weeds, green grasses, woven bags, denim, and cotton fabrics were used as typical trash. Under different amounts of trash, approach velocities and water depths, the movement and aggregation characteristics of the trash were observed and measured. The water level difference and the velocity distributions of cross-sections near trash racks were measured and analysed. A general dimensionless expression was advanced to calculate the head loss coefficient of the trash rack. We introduced the local head loss formula of trash rack blockage based on measured velocity distributions. The results indicate that the water level difference is related to blocked trash characteristics and the approach velocity. The velocity distributions are determined by the blocked location and blocked area on the rack surface. Backflow occurs in severe blockage, which makes the velocity distribution uneven and increases the local head loss.

PEMBEKALAN PRANIKAH UNTUK MENINGKATKAN KESIAPAN KOMUNIKASI BAGI REMAJA USIA SIAP MENIKAH DI KECAMATAN JUMAPOLO, KARANGANYAR

This participatory action research aims to improve communication readiness and problem solving for adolescents of marriage-ready age in Jumapolo sub-district. This research involved adolescents of marriage-ready age and adolescents ready for marriage, the Head of the Religious Affairs Office of Jumapolo Sub-district, local village heads, lecturers and students of the Islamic Institute of Mamba'ul 'Ulum Surakarta. Researchers begin by making observations at the research site, interviews with stakeholders, determining activities in the form of seminars and focus group discussions with participants. The qualitative data of the study were analyzed using descriptive analysis. The results showed changes in participants' perceptions of communication and problem solving in the household. This activity is very important to be held to understand the characteristics of the couple, as a provision for establishing good communication in a household, how to solve problems well so as to prevent divorce.

Infantile Haemangioma in the Romanian Paediatric Population-Characteristics and Therapeutic Approaches.

Infantile haemangioma (IH) is the most common benign tumour in childhood, with an incidence of 4% to 12%. Aim: to describe the characteristics of infantile haemangioma in a sample of Romanian children <2 years old at diagnosis, types of treatment applied, recorded complications and the response to the therapeutic approach. A two-year prospective case series study (August 2019 to August 2021) was carried out. Sample: 117 patients <24 months of age diagnosed with IH at the Emergency Hospital for Children "Marie Sklodowska Curie", in Bucharest, Romania. Five therapeutic approaches were used: oral treatment with propranolol, local treatment with timolol, surgical treatment, topical treatment with steroids and no treatment ("wait and see"). Recorded factors mentioned in the literature were also present in this study population: female patients-68.4%; phototype I-58%. In 53% of cases, IHs had a head and neck location and 10% developed local complications (traumatic bleeding). The majority of patients (86%) required one type of therapy: oral propranolol (51%). A low relapse rate was recorded (4%). We consider that any child with a vascular anomaly should be referred to a highly specialised medical service for therapeutic approach.

Sosialisasi Komunitas Permainan Tradisional Di Desa Blitar

The purpose of this Community Service is to provide information to Blitar Village managers about traditional games such as crank and dragon snake. This activity was carried out directly (face to face) with representatives of the Belitar Seberang village community and the tourism village management committee at the Village Hall with the approval of the local village head. Apart from being packaged in the form of socialization, this activity was also complemented by activities that went directly to the field and practiced traditional games. Based on the results of the activity, it can be concluded that community service activities in Belitar Seberang Village have great benefits for the village in developing their village's potential to make it more famous. Apart from traveling, visitors also get information on traditional games and can play games such as crank and dragon snake. For the Physical Education Study Program itself, apart from being one of the embodiments of the Tridharma of Higher Education in the community, this activity is also a forum for the team of lecturers to channel their knowledge to the community through traditional games.

Aberrant p16, p53 and Ki-67 immunohistochemistry staining patterns can distinguish solitary keratoacanthoma from cutaneous squamous cell carcinoma

Keratoacanthoma (KA) is widely considered a benign, usually self-resolving, neoplasm distinct from cutaneous squamous cell carcinoma (cSCC), while some consider KA to be indistinguishable from cSCC. Published studies indicate utility for p16, p53, Ki-67 immunostaining and elastic van Gieson (EVG) in the assessment of KA and cSCC. We compared clinical features and staining patterns for p16, p53, Ki-67 and EVG in fully excised KA, cSCC with KA-like features (cSCC-KAL) and other cSCC (cSCC-OTHER). Significant differences between KA, cSCC-KAL and cSCC-OTHER were found for head and neck location (20%, 86%, 84%), and duration <5 months (95%, 63%, 36%). KA shows both a mosaic pattern for p16 (>25-90% of neoplasm area) and peripheral graded pattern for p53 (up to 50% moderate and strong nuclear staining) in 92% compared with 0% of cSCC-KAL and 0% of cSCC-OTHER. In contrast, a highly aberrant pattern (usually null) for one or both p16 and p53, was present in 0% of KA, 83.8% of cSCC-KAL and 90.9% of cSCC-OTHER. Abnormal distribution of Ki-67 beyond the peripheral 1-3 cells was uncommon in KA (4.2%) and common in cSCC-KAL (67.6%) and cSCC-OTHER (88.4%). Moderate to striking entrapment of elastic and collagen fibres was present in the majority of KA (84%), cSCC-KAL (81%) and cSCC-OTHER (65%). KA are clinically distinct neoplasms typically of short duration occurring preferentially outside the head and neck and generally lacking aberrations of p16, p53 and Ki-67, compared with cSCC that have high rates of aberrant or highly aberrant p16, p53 and Ki-67, but EVG lacked specificity.

Do the Clinical Characteristics of Lipomas Influence the Incision Length During Minimal Incision Extraction?

Minimal incision extraction technique is widely accepted for the surgical removal of lipomas, but no consensus for the incision length has been made yet. To investigate the clinical characteristics of lipomas which affect the minimal incision length during the minimal incision extraction. We retrospectively analyzed 50 patients who underwent minimal incision extraction for 55 medium-sized (3-5 cm) or large lipomas (> 5 cm) between March 2020 and May 2022. If the mass is not fully dissected, or adequate visual field for hemostasis was not provided through the initial one-third incision, the incision was extended to the minimal extent. There were 33 males and 17 females with a mean age of 53.5 ± 12.7 years. There was no statistical difference in the minimal % incision length, defined as [(incision length) / (tumor diameter)] x 100, between the medium-sized (n = 31) and large lipomas (n = 24). Lipomas of the long incision group (minimal % incision length ≥66.7%, n = 21) had a higher frequency of head and neck location than lipomas of the short incision group (minimal % incision length <66.7%, n = 34) (odds ratio = 14.5, P < .05). However, no association was found between the tumor diameter or depth and the minimal % incision length. The occurrence of postoperative complications was not associated also (P = .296). The minimal % incision length for lipoma removal does not show statistical difference between medium-sized and large lipomas, and is affected by its anatomical location, but not by tumor diameter or depth.

Histologic margin status is a predictor of relapse in lentigo maligna melanoma

Most surgical margins for lentigo maligna melanomas reported in the literature are clinical and not histologic. We sought to determine whether histologic margin status is an independent predictor of progression. Clinicopathologic information of 268 invasive lentigo maligna melanomas diagnosed from 1990-2019 were analyzed. Statistical analyses were performed using Cox proportional hazards model and Boruta method. A total of 75% of the lesions were located on the head and neck. The range of follow-up for all patients was 0 to 31.8years (median, 10.2years). Time to local recurrence ranges from 0 to 20years (median, 3years). Progression developed in 54 (20.1%) of 268 patients. Local recurrence was seen only in 36 (13.4%), both local recurrence and subsequent metastasis in 7 (2.6%), and only metastasis in 11 (4.1%) of 268 patients. Histologic margin status (positive and close/<3mm) and tumor site (head and neck location) significantly correlated with worse progression-free survival. Single institution and retrospective study. Histologic margin status is the strongest predictor of progression for lentigo maligna melanoma. Patients with positive or close/<3mm histologic margins should consider a re-excision due to the increased risk of relapse.

Shielding Analysis of a Preclinical Bremsstrahlung X-ray FLASH Radiotherapy System within a Clinical Radiation Therapy Vault.

A preclinical radiotherapy system producing FLASH dose rates with 12 MV bremsstrahlung x rays is being developed at Stanford University and SLAC National Accelerator Laboratory. Because of the high expected workload of 6,800 Gy w -1 at the isocenter, an efficient shielding methodology is needed to protect operators and the public while the preclinical system is operated in a radiation therapy vault designed for 6 MV x rays. In this study, an analysis is performed to assess the shielding of the local treatment head and radiation vault using the Monte Carlo code FLUKA and the empirical methodology given in the National Council on Radiation Protection and Measurements Report 151. Two different treatment head shielding designs were created to compare single-layer and multilayer shielding methodologies using high-Z and low-Z materials. The multilayered shielding methodology produced designs with a 17% reduction in neutron fluence leaking from the treatment head compared to the single layered design of the same size, resulting in a decreased effective dose to operators and the public. The conservative assumptions used in the empirical methods can lead to over-shielding when treatment heads use polyethylene or multilayered shielding. High-Z/Low-Z multilayered shielding optimized via Monte Carlo is shown to be effective in the case of treatment head shielding and provide more effective shielding design for external beam radiotherapy systems that use 12 MV bremsstrahlung photons. Modifications to empirical methods used in the assessment of MV radiotherapy systems may be warranted to capture the effects of polyethylene in treatment head shielding.